Presentation
Respiratory distress and loss of consciousness following a prolonged surgery for a right lower limb gunshot wound
Patient Data
There is evidence of serpiginous air densities in sulci of the parietal and occipital lobes of both cerebral hemispheres.
The patient admitted to ICU for mechanical ventilation due to respiratory failure and hemodynamic instability. A follow-up brain CT was performed after 24 hours.
There is interval development of hypodensities in both cortical and subcortical regions of both cerebral hemispheres. This indicate multiple cortical infarctions and brain edema with evidence of transtentorial herniation.
Case Discussion
The patient demonstrates a massive cerebral air embolism. The exact cause is unknown; however, multiple venous lines were present. Air densities in sulci rapidly resolved and multiple cerebral infarctions and brain edema developed.
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